不同方式超前镇痛对儿童腹腔镜术后多模式镇痛效果的影响

Effect of multimodal analgesia by different ways of preemptive analgesia after laparoscopic surgery in children

目的 观察不同方式超前镇痛对儿童腹腔镜术后多模式镇痛安全性及效果的影响.方法 选择在全身麻醉下接受择期腹腔镜手术的患儿90例,年龄5～ 14岁,美国麻醉医师协会（ASA）分级Ⅰ～Ⅱ级.采用完全随机双盲法均分为对乙酰氨基酚栓塞肛组（A组）、布托啡诺喷鼻组（B组）和空白对照组（C组）.A组患儿全身麻醉后予对乙酰氨基酚栓40 mg/kg塞肛;B组患儿予布托啡诺20μg/kg喷鼻;C组于手术开始前10 min缓慢静脉注射生理盐水2 ml.监测三组患儿术后的心率（HR）、平均动脉压（MAP）、血氧饱和度（SpO2）、拔管时间和在PACU停留时间.记录患儿的VAS评分、Ramsay镇静评分及不良反应.结果 A组和B组苏醒期躁动评分显著低于C组（P＜0.01）.B组镇静评分显著高于A组和C组（P＜0.01）,A组也高于C组（P＜0.05）.术后1、4hA组、B组VAS评分显著低于C组（P＜0.01）,术后8 h VAS评分低于C组（P＜0.05）;术后1、4、8hB组VAS评分低于A组（P＜0.05）.C组术后首次按压镇痛泵的时间早于A组和B组（P＜0.01）,且按压总次数明显多于A组和B组（P＜ 0.01）.结论 对乙酰氨基酚栓塞肛和布托啡诺喷鼻均可为儿童腹腔镜手术提供同样安全、有效的超前镇痛效果,但前者不良反应更少,较适合在基层中推广使用.

Objective To observe the abirritation effect and safety of multimodal analgesia by different ways of preemptive analgesia after laparoscopic surgery in children.Methods 90 patients （5-14 years old,ASA Ⅰ ～ Ⅱ） scheduled for laparoscopic surgery were selected.With a completely randomized and double blind method,they were divided into three groups with 30 patients in each group.Group A received acetaminophen suppository 40 mg/kg by rectal administration after general anesthesia.Group B received transnasal butorphanol 20 μ g/kg after general anesthesia.Group C received an injection of 2 ml saline before the operation.We observed the HR and BP,RR and SPO2,the time of tracheal extubation and residence time of PACU in three groups.Then we recorded VAS score,Ramsay sedation score and adverse reactions of patients.Results The emergence agitation score in group A and B were significantly lower than those in group C （P 〈 0.01）.The Ramsay score in group B was significantly higher than those in group A and C （P 〈 0.01）,and the score in group A was higher than that in group C （P 〈 0.05）.The VAS score of group A and B were significantly lower than that in group C （P 〈 0.01） 1 and 4 hours after operation,and it was lower than that in group C 8 hours after operation （P 〈 0.05）.The VAS score of group B was lower than that in group A 1,4 and 8 hours after operation （P 〈 0.05）.The first time to press analgesia pump （PCIA） in group C was significantly earlier than those in group A and B （P 〈 0.01）,and the times of press were more significantly than those in group A and B （P 〈 0.01）.Conclusion Both acetaminophen suppository by rectal administration and transnasal butorphanol administration have the same safe and effective preemptive analgesia effect.But the former has less adverse reactions,which is more suitable for application in the primary hospitals.